IN NETWORK. If my treating dentist is in-network with my dental insurance plan, I will be billed pursuant to the terms of my insurance policy and my dentist’s contract with the insurer. Even when the practice and my treating dentist are a participating provider with my insurance, I understand that the practice may hold me responsible and collect all charges in any one of the following situations: ● When I choose to have a service that my dental plan covers but I do not obtain the required referral or prior authorization from my health plan. ● When I choose not to use my dental plan and agree to pay for services myself. ● When I receive services that are not covered under my dental plan
IN NETWORK. Premium is the Commercial Plan Premium, as defined in Product Attachment A, billed or accounted for by PacifiCare for coverage of In-Network Services under the PacifiCare Commercial POS Plan.
IN NETWORK. United Health Care participating providers accept fees as payment in full and agree not to bill members for any remaining balances. Members are responsible only for stated co- payments. No claim forms are required to be completed by plan members. Out of Network: Benefits are paid using Reasonable and Customary (R&C) guidelines. R&C refers to charges or fees of a physician which are frequently determined by set services offered over a period of time within a specific geographic area. Fees charged by non- participating providers in excess of R&C limits will be the employee's responsibility and do not help satisfy out-of-pocket limits or deductibles. Any claim form required to be filed will be the plan participant's responsibility. This Benefit Summary is intended to be a brief description of health care benefits available for employees and eligible dependents. More detail is provided in your plan booklet.
IN NETWORK. Medical Provider An in-network medical provider is one contracted with the insured person’s policy to provide services to policy members for specific pre-negotiated rates.
IN NETWORK. If I am in your insurance network, you are expected to pay the fee required by your insurance company at the time of service. If benefits have not been verified, you will be expected to pay the full service fee (listed above). You are responsible for knowing the details of your insurance coverage and obtaining authorizations as required by your health plan. I will file with your insurance carrier, however you will want to call and verify your mental health coverage prior to your appointment. The policies and procedures of your insurance health plan will govern fees and payment of fees for professional services. All fees that are not covered by your insurance carrier are your responsibility. *Please note that most insurance companies DO NOT cover marriage therapy and you will be required to pay the full fee of $120.00 per 55-minute session.
IN NETWORK. (Contracted) Services Contractor shall be responsible for making timely payment and meet the requirements of 42 CFR 447.45 and 42 CFR 447.46 for Medically Necessary, Covered Services rendered by in-network providers when: • Services were rendered under the terms of the Dental Plan’s contract with the provider • Services were prior authorized A claim means (1) a xxxx for services, (2) a line item of service, or (3) all services for one enrollee within a xxxx. A clean claim means one that can be processed without additional information from the provider of service or from a third party. It includes a claim with errors originating in the State’s claims system. It does not include a claim from a provider who is under investigation for fraud or abuse, or a claim under review for medical necessity. Timely payment means within thirty (30) days of receipt of a "clean claim" for reimbursement. Timely payment is judged by the date that the contractor receives the claim as indicated by its date stamped on the claim and the date of payment is the date of the check or other form of payment.
IN NETWORK. A planned material change in Network operations cannot be made by I@I without the prior written consent of the Governing Body. A "material change" includes, but is not limited to, a change which increases response time to inquiries, adds to the complexity of system use, diminishes services provided to users, or results in a comparable impact on operations noticeable by users. I@I will provide to the Governing Body at least thirty (30) days, prior written notice of a planned material change in Network operations.
IN NETWORK. Home and Office Care Home or Office Visit Emergency Care Emergency Room Care Outpatient Surgery Inpatient Hospital Services Per Admission High Cost Diagnostics Unlimited Maximum Prescription Benefits $15.00 (0% for preventative visits) $75.00 $150.00 $250.00 $75.00 to an annual maximum of $375
IN NETWORK. If my treating provider is in-network with my health insurance plan, I will be billed pursuant to the terms of my insurance policy and my providers contract with the insurer. Even when the practice and my treating provider are a participating provider with my insurance, I understand that the practice may hold me responsible and collect all charges in any one of the following situations: ● When I choose to have a service that my health plan covers but I do not obtain the required referral or prior authorization from my health plan. ● When I choose not to use my health plan and agree to pay for services myself. ● When I receive services that are not covered under my health plan
